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  • Mina Gaga
    Asthma often complicates pregnancy while asthma exacerbations may cause hypoxemia of the mother and fetus and threaten the outcome of pregnancy. It is imperative to properly treat asthma with medications that have been proven to be safe for the fetus. This review discusses the impact of asthma on pregnancy as well as the current guidelines on the treatment of asthma during pregnancy. Pneumon 2002, 15(2):137-142.
     
  • cytokines, atopy, Asthma
    Recent findings suggest that extrinsic and intrinsic asthma, despite showing distinct clinical features, share many common immunopathological mechanisms. Inappropriate IgE-mediated mechanisms might occur in asthma, irrespective of its atopic status, as suggested by elevated serum IgE concentrations and bronchial mucosal expression of cells positive for FcεΡΙ, IL-4, IL-13, Iε and Cε. Future directions of research regarding intrinsic asthma include possible identification of novel allergens, detailed description of local bronchial mucosal IgE production and understanding of a possible macrophage dysfunction. In addition, a role for infectious or autoimmune processes has yet to be firmly identified. Pneumon 2002, 15(2):143-146.
     
  • The lung collapse pattern was studied in 10 intubated adult patients with acute respiratory distress syndrome (ARDS). Tracheal pressure (Ptr), airway pressure (Paw), airflow (V’) and volume (V) at four different PEEP levels (0, 5, 10, 15 cm H2O) were continually recorded. Expiratory volume (passive expiration) was divided in four equal contiguous segments; time constant (τe) and static respiratory compliance (Crs) of each segment were separately calculated using linear regression analysis of V/V’ and V/Ptr ratios, respectively. The τe/Crs ratio was used for the calculation of total expiratory resistance (Rtot, the sum of the respiratory system resistance [Rrs], plus the endotracheal tube airflow resistance [Rtube], plus the ventilator circuit resistance [Rvent]). In the presence of expiratory flow limitation, Rrs was assumed equal to RTOT. If no expiratory flow limitation was documented, Rrs was calculated as Rtot minus the sum of Rtube plus Rvent. The time constant of the respiratory system (τers) is represented by the product of Rrs and Crs. At zero PEEP (ZEEP), τers was shown to increase significantly from the beginning toward the end of expiration (Δτers 55.5±31%) due to the marked increase in Rrs (ΔRrs 63.9±45%). When PEEP was applied, Rrs was maintained relatively constant throughout expiration, the collapse rate of the respiratory system increased and the difference in τers from the beginning toward the end of expiration reduced. Conclusively, the lungs of ARDS patients demonstrate a nonhomogeneous collapse rate during expiration as a result of a marked increase in respiratory system resistance observed in low lung volumes. The use of PEEP leads to a homogeneous and higher lung collapse rate. Pneumon 2002, 15(2)147-157.
     
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  • SUMMARY. Τhe objective and subjective burden imposed on the families of patients under LTOT and MV, as well as their General Health Score was estimated in 32 family members (56.7% husband /wife, 33.3% child) with mean duration of common life 29.7 years and daily contact rate 96%. A profound objective burden was revealed in the field of social activities in 57.7% of the families, home care managing in 46.7%, financial condition in 43.3%, occupation activities in 30% and satisfaction with medical services in 27.6% of the families. The subjective burden rates were respectively lower. The strategies adopted by the families in order to cope with the imposed burden were: reevaluation of their aims in 90% of the families, resignation 86.1%, passivity in 50%, hopefulness in 50%, guilt in 16.6% and ambivalence in 17% of the families. General Health Score was >4 in 69.7% of the relatives and it was significantly related with the objective burden imposed in social activities (r=0.61, p<0.05) and occupation activities (r=0.70, p<0.01), as well as with the subjective burden on home care managing (r=0.78, p<0.01) and financial condition (r=0.76, p<0.01). The families of patients with CRI seem to face major problems (severe burden) in their social relations and financial condition. On the contrary, they seem to be satisfied (absence of burden) with the provided medical services. Families do not seem to experience subjectively the burden that is objectively recorded and, in their vast majority, they adopt healthy coping strategies. Nevertheless, a high rate of them is estimated to be in great risk of developing mental disorders. Pneumon 2002, (2):183-188
     
  • Streptococcus pneumoniae is the most frequent cause of community acquired pneumonia (CAP). Conventional diagnostic methods are frequently not rapid nor sensitive enough, to guide initial antibiotic therapy. A new method of a rapid immunochromatographic test (ICT), Binax NOW Streptococcus Pneumoniae Urinary Antigen Test, by Binax, increases the diagnostic yield for pneumococci in patients with CAP. The sensivity and specifitidy of the test is 80,4% and 97,2% respectively, results are given in 15΄, it is technically simple and it does not require any special equipment. We performed the ICT test for the detection of PnC antigen of pneumococcus in urine, in 66 patients with CAP. PnC was detected in 14/66 (21,2%) of cases. In only 1/14 case (7,1%) there was a positive result in the blood culture, while in 9/14 (64,3%) of cases, all results were negative by conventional methods. In conclusion, the ICT method for the detection of S.pneumoniae antigen in urine, with the Binax NOW pneumococcus Urinary Antigen Test, in patients with CAP, allows a rapid diagnosis of a pneumococcal infection and increases the efficiency of conventional methods. Pneumon 2002, (2):189-195.
     
  • Special Article. ICU Assistant Director, Hippokratio General Regional Hospital, Athens
     
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